Indiana has at least a dozen trauma hospitals which could respond in the event of a mass shooting like the one in Las Vegas Sunday night. But those campuses have varying capabilities.

Only four hospitals, all in Indianapolis, are rated as “trauma one”– the highest rating, with doctors specializing in certain types of surgery that may be required after a severe wound.

Indiana Hospital Association Vice President Spencer Grover says all the state’s trauma centers are in big cities, because that’s where they tend to be needed most often.

“Where you have, usually, bigger populations, higher industry, higher trauma incidence because of transportation or just higher population density, you usually have more need for trauma-like services,” he says.

But a wide swath of southern and southeastern Indiana has no trauma facilities in-state. As a result, Grover says, areas like Indianapolis are better-served following events such as the 2011 collapse of a stage at the Indiana State Fair, which killed seven people and injured 58 others.

But IU Health Methodist Hospital trauma program manager Jill Castor says even the four trauma hospitals in Indianapolis would be taxed by an event with the scope of the Las Vegas shootings.

“Those systems are in place to where they know where to send patients to not overwhelm them," Castor says. "Now in a situation like what happened at Las Vegas, everyone’s going to be overwhelmed regardless.”